The dietary intake of patients with chronic pancreatitis: a systematic review and meta-analysis

Abstract

Purpose: Chronic pancreatitis (CP) is a fibro-inflammatory disorder of the pancreas that results in under-nutrition due to loss of endocrine and exocrine function. While up to half of patients with chronic pancreatitis are malnourished, their dietary intake is relatively understudied and has not been systematically reviewed. The objective of this study was to assess energy and macro-nutrient intake of patients with CP versus controls, and to compare the intakes of patients with alcohol-related CP to those with non-alcohol-related CP. Methods: Three databases (EMBASE, MEDLINE, Cochrane review) were assessed for studies analysing dietary intake in patients with CP between 1946 and August 30th 2019. Adult subjects with a diagnosis of CP who had undergone dietary assessment were included in the systematic review (qualitative analysis). Studies on patients with other pancreatic diseases or undergone pancreatic surgery were excluded. Studies comparing the dietary intake of patients with CP to that of healthy controls were included in the meta-analysis (quantitative analysis). Results: Of 6,715 studies retrieved in the search, 23 were eligible for qualitative analysis while 12 were eligible for meta-analysis. In the meta-analysis, the total energy (calorie) intake of patients with CP was similar to that of healthy controls (mean difference (MD): 171.3; 95% confidence interval (CI): -226.01, 568.5; P=0.4). Patients with CP consumed significantly fewer non-alcohol calories than controls (MD: -694.1; 95%CI: -1,256.1, -132.1; P=0.02)(Figure 1). CP patients consumed more protein, but carbohydrate and fat intakes did not differ significantly. Those with alcohol-related CP consumed more mean (standard deviation) calories than CP patients with a non-alcohol aetiology (2,642(1,090)kcal and 1,372 (394)kcal, respectively, P=0.046), as well as more protein, fat, but not carbohydrate Conclusion: Although patients with CP consumed more calories than controls, studies that analysed the contribution of alcohol to energy intake showed that patients with CP consumed fewer non-alcohol calories than healthy controls. A high calorie intake, made up to a large degree by alcohol, may in part contribute to poor nutritional status in CP. Further studies, with robust study designs, should aim to characterise the dietary intake of patients with CP.